Gonadotropin releasing hormone analogue therapy in girls with idiopathic precocious puberty/early-fast puberty: dynamics in adiposity indices, eating habits and quality of life
-
Shiran Abargil Loochi
, Sharon Demol , Nessia Nagelberg , Yael Lebenthal , Moshe Phillip und Michal Yackobovitch-Gavan
Abstract
Background
The impact of gonadotropin-releasing-hormone-analogue (GnRHa) treatment on weight and body composition is controversial. Exploring the nutritional, psychological patterns of this population may aid to clarify this propensity to gain weight. This prospective observational study aimed to evaluate longitudinal changes in adiposity, nutrition and quality of life in girls with central precocious/early-fast puberty (CPP/EFP) during GnRHa treatment.
Methods
Thirty-two GnRHa-treated girls with CPP/EFP and 27 prepubertal girls (7–10 years) were included in the analysis. Outcome measures assessed at baseline for CPP/EFP and the control groups and during up to two years of GnRHa treatment for the CPP/EFP group, included anthropometrics, body-composition, basal-metabolic-rate (BMR), 3-day food-diaries, child eating-behavior questionnaire, and pediatric quality-of-life questionnaire (PedsQL).
Results
Girls with CPP/EFP had higher pretreatment BMI-SDS, fat percentages, waist circumference and waist-per-height (p<0.01 for all), and lower psychosocial functioning than controls (p<0.05). Changes in anthropometric and body composition measurements indicated a gradual increase in adiposity and a decrease in muscle mass (p<0.001 for all). Dynamics in body composition could not be explained by the participants’ self-reported dietary patterns and physical activity levels or by the measured BMR, which revealed an adequate and relatively low energy intake as compared to energy requirements. A gradual decline in physical functioning (PedsQL) after one and two years of GnRHa treatment was observed (p<0.001).
Conclusions
Our findings highlight the need for comprehensive surveillance in girls with CPP/EFP. Dynamics in weight status and body composition during GnRHa treatment indicate the need for tailored nutritional and physical activity counseling aimed at preventing obesity.
Acknowledgements
The authors thank Ruth Fradkin for editorial assistance. The authors thank the participating children and their families who made this study possible. Appreciation is also expressed to our research coordinators and to the study nurses. Parts of this data were presented in poster form at the sixth International Conference on Nutrition & Growth, March 2019, Valencia, Spain.
Research funding: None declared.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Competing interests: Authors state no conflict of interest.
References
1. Carel, JC, Eugster, EA, Rogol, A, Ghizzoni, L, Palmert, MR. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics 2009;123:e752–62. https://doi.org/10.1542/peds.2008-1783.Suche in Google Scholar
2. Eugster, EA. Treatment of central precocious puberty. J Endocr Soc 2019;3:965–72. https://doi.org/10.1210/js.2019-00036.Suche in Google Scholar
3. Bangalore Krishna, K, Fuqua, JS, Rogol, AD, Klein, KO, Popovic, J, Houk, CP, et al.. Use of gonadotropin-releasing hormone analogs in children: update by an International Consortium. Horm Res Paediatr 2019;91:357–72. https://doi.org/10.1159/000501336.Suche in Google Scholar
4. Chen, C, Zhang, Y, Sun, W, Chen, Y, Jiang, Y, Song, Y, et al.. Investigating the relationship between precocious puberty and obesity: a cross-sectional study in Shanghai, China. BMJ Open 2017;7:e014004. https://doi.org/10.1136/bmjopen-2016-014004.Suche in Google Scholar
5. Fuqua, JS. Treatment and outcomes of precocious puberty: an update. J Clin Endocrinol Metab 2013;98:2198–207. https://doi.org/10.1210/jc.2013-1024.Suche in Google Scholar
6. Takahashi, LAR, Dos Santos Figueiredo, FW, Benedet, J, de Vasconcelos, FAG, Adami, F. Influence of sexual maturation status on the relationship between body adiposity indicators and age: a cross-sectional study. BMC Res Notes 2019;12:61. https://doi.org/10.1186/s13104-019-4095-5.Suche in Google Scholar
7. Aguiar, AL, Couto-Silva, AC, Vicente, EJ, Freitas, IC, Cruz, T, Adan, LF. Weight evolution in girls treated for idiopathic central precocious puberty with GnRH analogues. J Pediatr Endocrinol Metab 2006;19:1327–34. https://doi.org/10.1515/jpem.2006.19.11.1327.Suche in Google Scholar
8. Arcari, AJ, Gryngarten, MG, Freire, AV, Ballerini, MG, Ropelato, MG, Bergada, I, et al.. Body mass index in girls with idiopathic central precocious puberty during and after treatment with GnRH analogues. Int J Pediatr Endocrinol 2016;15. https://doi.org/10.1186/s13633-016-0033-7.Suche in Google Scholar
9. Arrigo, T, De Luca, F, Antoniazzi, F, Galluzzi, F, Segni, M, Rosano, M, et al.. Reduction of baseline body mass index under gonadotropin-suppressive therapy in girls with idiopathic precocious puberty. Eur J Endocrinol 2004; 150:533–7. https://doi.org/10.1530/eje.0.1500533.Suche in Google Scholar
10. Chiocca, E, Dati, E, Baroncelli, GI, Mora, S, Parrini, D, Erba, P, et al.. Body mass index and body composition in adolescents treated with gonadotropin-releasing hormone analogue triptorelin depot for central precocious puberty: data at near final height. Neuroendocrinology 2009;89:441–7. https://doi.org/10.1159/000197862.Suche in Google Scholar
11. Chiumello, G, Brambilla, P, Guarneri, MP, Russo, G, Manzoni, P, Sgaramella, P. Precocious puberty and body composition: effects of GnRH analog treatment. J Pediatr Endocrinol Metab 2000;13:791–4. https://doi.org/10.1515/jpem.2000.13.s1.791.Suche in Google Scholar
12. Guaraldi, F, Beccuti, G, Gori, D, Ghizzoni, L. Long-term outcomes of the treatment of central precocious puberty. Eur J Endocrinol 2016;174:R79–87. https://doi.org/10.1530/eje-15-0590.Suche in Google Scholar
13. Lazar, L, Kauli, R, Pertzelan, A, Phillip, M. Gonadotropin-suppressive therapy in girls with early and fast puberty affects the pace of puberty but not total pubertal growth or final height. J Clin Endocrinol Metab 2002;87:2090–4. https://doi.org/10.1210/jcem.87.5.8481.Suche in Google Scholar
14. Lee, HS, Yoon, JS, Roh, JK, Hwang, JS. Changes in body mass index during gonadotropin-releasing hormone agonist treatment for central precocious puberty and early puberty. Endocrine 2016;54:497–503. https://doi.org/10.1007/s12020-016-1023-5.Suche in Google Scholar
15. Palmert, MR, Mansfield, MJ, Crowley, WFJr, Crigler, JFJr, Crawford, JD, Boepple, PA. Is obesity an outcome of gonadotropin-releasing hormone agonist administration? Analysis of growth and body composition in 110 patients with central precocious puberty. J Clin Endocrinol Metab 1999;84:4480–8. https://doi.org/10.1210/jcem.84.12.6204.Suche in Google Scholar
16. Paterson, WF, McNeill, E, Young, D, Donaldson, MD. Auxological outcome and time to menarche following long-acting goserelin therapy in girls with central precocious or early puberty. Clin Endocrinol 2004; 61:626–34. https://doi.org/10.1111/j.1365-2265.2004.02146.x.Suche in Google Scholar
17. Traggiai, C, Perucchin, PP, Zerbini, K, Gastaldi, R, De Biasio, P, Lorini, R. Outcome after depot gonadotrophin-releasing hormone agonist treatment for central precocious puberty: effects on body mass index and final height. Eur J Endocrinol 2005; 153:463–4. https://doi.org/10.1530/eje.1.01975.Suche in Google Scholar
18. van der Sluis, IM, Boot, AM, Krenning, EP, Drop, SL, de Muinck Keizer-Schrama, SM. Longitudinal follow-up of bone density and body composition in children with precocious or early puberty before, during and after cessation of GnRH agonist therapy. J Clin Endocrinol Metab 2002; 87:506–12. https://doi.org/10.1210/jcem.87.2.8202.Suche in Google Scholar
19. Wolters, B, Lass, N, Reinehr, T. Treatment with gonadotropin-releasing hormone analogues: different impact on body weight in normal-weight and overweight children. Horm Res Paediatr 2012; 78:304–11. https://doi.org/10.1159/000346145.Suche in Google Scholar
20. Yang, WJ, Ko, KH, Lee, KH, Hwang, IT, Oh, YJ. The different effects of gonadotropin-releasing hormone agonist therapy on body mass index and growth between normal-weight and overweight girls with central precocious puberty. Ann Pediatr Endocrinol Metab 2017;22:49–54. https://doi.org/10.6065/apem.2017.22.1.49.Suche in Google Scholar
21. Heo, JS, Moon, HS, Kim, MK. A study on dietary habits and lifestyle of girls with precocious puberty. Pediatr Gastroenterol Hepatol Nutr 2016;19:130–8. https://doi.org/10.5223/pghn.2016.19.2.130.Suche in Google Scholar
22. Kim, YJ, Lee, HS, Lee, YJ, Lim, JS, Kim, SY, Kim, EY, et al.. Multicenter clinical trial of leuprolide acetate depot (Luphere depot 3.75 mg) for efficacy and safety in girls with central precocious puberty. Ann Pediatr Endocrinol Metab 2013;18:173–8. https://doi.org/10.6065/apem.2013.18.4.173.Suche in Google Scholar
23. Mensah, FK, Bayer, JK, Wake, M, Carlin, JB, Allen, NB, Patton, GC. Early puberty and childhood social and behavioral adjustment. J Adolesc Health 2013;53:118–24. https://doi.org/10.1016/j.jadohealth.2012.12.018.Suche in Google Scholar
24. Williams, VSL, Soliman, AM, Barrett, AM, Klein, KO. Review and evaluation of patient-centered psychosocial assessments for children with central precocious puberty or early puberty. J Pediatr Endocrinol Metab 2018;31:485–95. https://doi.org/10.1515/jpem-2017-0465.Suche in Google Scholar
25. Marshall, WA, Tanner, JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969; 44:291–303. https://doi.org/10.1136/adc.44.235.291.Suche in Google Scholar
26. Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, DC: National Academy Press; 2005.Suche in Google Scholar
27. Wardle, J, Guthrie, CA, Sanderson, S, Rapoport, L. Development of the children’s eating behaviour questionnaire. J Child Psychol Psychiatry 2001;42:963–70. https://doi.org/10.1111/1469-7610.00792.Suche in Google Scholar
28. Varni, JW, Seid, M, Kurtin, PS. PedsQLTM 4.0: reliability and validity of the pediatric quality of life inventory TM version 4.0 generic core scales in healthy and patient populations. Med Care. 2001;39:800–12. https://doi.org/10.1097/00005650-200108000-00006.Suche in Google Scholar
29. Kuczmarski, RJ, Ogden, CL, Grummer-Strawn, LM, Flegal, KM, Guo, SS, Wei, R, et al.. 2000 CDC growth charts: United States. Adv Data 2000;314:1–27.Suche in Google Scholar
30. Taylor, RW, Jones, IE, Williams, SM, Goulding, A. Evaluation of waist circumference, waist to-hip ratio, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy x-ray absorptiometry, in children aged 3–19 years. Am J Clin Nutr 2000;72:490–5. https://doi.org/10.1093/ajcn/72.2.490.Suche in Google Scholar
31. Jensen, NS, Camargo, TF, Bergamaschi, DP. Comparison of methods to measure body fat in 7-to-10-year-old children: a systematic review. Publ Health 2016;133:3–13. https://doi.org/10.1016/j.puhe.2015.11.025.Suche in Google Scholar
32. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2005;114:555–76.10.1542/peds.114.2.S2.555Suche in Google Scholar
33. Israel Center for Disease Control and the Ministry of Health. Tzameret 2 software. Israel Center for Disease Control and the Ministry of Health; 2012.Suche in Google Scholar
34. Hadani, S, Lebenthal, Y, Lazar, L, Shamir, R, Phillip, M, Yackobovitch-Gavan, M. Lean healthy children with short stature have distinct eating patterns. J Food Science Eng 2016;6:299–307.10.17265/2159-5828/2016.06.001Suche in Google Scholar
35. Yackobovitch-Gavan, M, Nagelberg, N, Demol, S, Phillip, M, Shalitin, S. Influence of weight-loss diets with different macronutrient compositions on health-related quality of life in obese youth. Appetite 2008;51:697–703. https://doi.org/10.1016/j.appet.2008.06.010.Suche in Google Scholar
36. IBM Corp. Released. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp; 2017.Suche in Google Scholar
37. The Israel Center for Disease Control (ICDC). The National health and nutrition (MABAT) Surveys. MABAT kids 2, 2015-2016. Available from: https://www.health.gov.il/publicationsfiles/mabat_kids2_11_2015-2016.pdf [Accessed 22 Oct 2020].Suche in Google Scholar
38. Heitmann, BL, Lissner, L. Dietary underreporting by obese individuals is it specific or nonspecific. Br Med J 1995;311:986–9. https://doi.org/10.1136/bmj.311.7011.986.Suche in Google Scholar
39. Nielsen, BM, Nielsen, MM, Toubro, S, Pedersen, O, Astrup, A, Sorensen, TIA, et al.. Past and current body size affect validity of reported energy intake among middle-aged Danishmen. J Nutr 2009;139:2337–43. https://doi.org/10.3945/jn.109.112599.Suche in Google Scholar
40. Ashcroft, J, Semmler, C, Carnell, S, van Jaarsveld, CH, Wardle, J. Continuity and stability of eating behaviour traits in children. Eur J Clin Nutr 2008;62:985–90. https://doi.org/10.1038/sj.ejcn.1602855.Suche in Google Scholar
41. Powell, FC, Farrow, CV, Meyer, C. Food avoidance in children. The influence of maternal feeding practices and behaviours. Appetite 2011;57:683–92. https://doi.org/10.1016/j.appet.2011.08.011.Suche in Google Scholar
42. Rahill, S, Kennedy, A, Walton, J, McNulty, BA, Kearney, J. The factors associated with food fussiness in Irish school-aged children. Publ Health Nutr 2019;22:164–74. https://doi.org/10.1017/s1368980018002835.Suche in Google Scholar
43. Schoelwer, MJ, Donahue, KL, Didrick, P, Eugster, EA. One-year follow-up of girls with precocious puberty and their mothers: do psychological assessments change over time or with treatment? Horm Res Paediatr 2017;88:347–53. https://doi.org/10.1159/000479688.Suche in Google Scholar
© 2021 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Review Article
- Inborn errors of immunity and metabolic disorders: current understanding, diagnosis, and treatment approaches
- Original Articles
- Evaluation of hydration status of children with obesity—a pilot study
- Relationship between insulin-like growth factor-1, insulin resistance and metabolic profile with pre-obesity and obesity in children
- Evaluation of Hemoglobin A1c before and after initiation of continuous glucose monitoring in children with type 1 diabetes mellitus
- Karyotype is associated with timing of ovarian failure in women with Turner syndrome
- The role of makorin ring finger protein-3, kisspeptin, and neurokinin B in the physiology of minipuberty
- Brain MRIs may be of low value in most children diagnosed with isolated growth hormone deficiency
- Significant improvement in bone mineral density in pediatric celiac disease: even at six months with gluten-free diet
- Population-based waist circumference reference values in Japanese children (0–6 years): comparisons with Dutch, Swedish and Turkish preschool children
- Extended growth charts for Indian children
- Rib fractures in infancy, case-series and register case-control study from Sweden
- Gonadotropin releasing hormone analogue therapy in girls with idiopathic precocious puberty/early-fast puberty: dynamics in adiposity indices, eating habits and quality of life
- Case Reports
- Transient benign hyperphosphatasemia due to COVID-19: the first case report
- ATP synthase deficiency due to m.8528T>C mutation – a novel cause of severe neonatal hyperammonemia requiring hemodialysis
- IgG4-related hypophysitis in adolescence
- Graves’ disease in a five-month-old boy with an unusual treatment course
- Oral sodium phenylbutyrate for hyperammonemia associated with congenital portosystemic shunt: a case report
- Severe multisystem organ dysfunction in an adolescent with simultaneous presentation of Addison’s and Graves’ disease
Artikel in diesem Heft
- Frontmatter
- Review Article
- Inborn errors of immunity and metabolic disorders: current understanding, diagnosis, and treatment approaches
- Original Articles
- Evaluation of hydration status of children with obesity—a pilot study
- Relationship between insulin-like growth factor-1, insulin resistance and metabolic profile with pre-obesity and obesity in children
- Evaluation of Hemoglobin A1c before and after initiation of continuous glucose monitoring in children with type 1 diabetes mellitus
- Karyotype is associated with timing of ovarian failure in women with Turner syndrome
- The role of makorin ring finger protein-3, kisspeptin, and neurokinin B in the physiology of minipuberty
- Brain MRIs may be of low value in most children diagnosed with isolated growth hormone deficiency
- Significant improvement in bone mineral density in pediatric celiac disease: even at six months with gluten-free diet
- Population-based waist circumference reference values in Japanese children (0–6 years): comparisons with Dutch, Swedish and Turkish preschool children
- Extended growth charts for Indian children
- Rib fractures in infancy, case-series and register case-control study from Sweden
- Gonadotropin releasing hormone analogue therapy in girls with idiopathic precocious puberty/early-fast puberty: dynamics in adiposity indices, eating habits and quality of life
- Case Reports
- Transient benign hyperphosphatasemia due to COVID-19: the first case report
- ATP synthase deficiency due to m.8528T>C mutation – a novel cause of severe neonatal hyperammonemia requiring hemodialysis
- IgG4-related hypophysitis in adolescence
- Graves’ disease in a five-month-old boy with an unusual treatment course
- Oral sodium phenylbutyrate for hyperammonemia associated with congenital portosystemic shunt: a case report
- Severe multisystem organ dysfunction in an adolescent with simultaneous presentation of Addison’s and Graves’ disease